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September 20, 1995, Vol 274, No. 11 >
ARTICLE | September 20, 1995

The Cost-effectiveness of Mammographic Screening Strategies FREE

Karen K. Lindfors, MD; C. John Rosenquist, MD
[+] Author Affiliations

Reprint requests to the Department of Radiology, University of California, Davis, School of Medicine, 2516 Stockton Blvd, Ticon II 216, Sacramento, CA 95817 (Dr Lindfors).


JAMA. 1995;274(11):881-884. doi:10.1001/jama.1995.03530110043033
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References

Objective.  —To compare and analyze the cost-effectiveness of different mammographic screening strategies.

Design.  —A computer simulation model was developed to compare mammographic screening with observation without screening. Cost-effectiveness was expressed as marginal cost per year of life saved (MCYLS) and was calculated for the following mammographic screening strategies: (1) annual for ages 40 to 79 years; (2) annual for ages 50 to 79 years; (3) biennial for ages 50 to 79 years; (4) annual for ages 40 to 49 years with biennial for ages 50 to 79 years; (5) annual for ages 40 to 64 years with biennial for ages 65 to 79 years; (6) biennial for ages 40 to 49 years with annual for ages 50 to 79 years; and (7) annual for high-risk and biennial for normal-risk women aged 40 to 49 years with annual for ages 50 to 79 years.

Data Sources.  —The probability and cost of all outcomes were established from previously published data or community experience.

Results.  —The most cost-effective screening strategy is biennial mammography for women aged 50 to 79 years, with an MCYLS of $16 000. Adding annual mammography for women aged 40 to 49 years increases the MCYLS to $20 200, but is more cost-effective than other tested protocols that included women in their 40s; annual mammography for ages 40 to 49 years with biennial for ages 50 to 79 years is also more cost-effective than annual mammography for ages 50 to 79 years.

Conclusion.  —Screening programs that include women in their 40s can be as cost-effective as some that exclude such women. Choice of a screening strategy depends on financial resources and desired effectiveness.(JAMA. 1995;274:881-884)

REFERENCES

1 +
Mettlin C, Smart CR.  Breast cancer detection guidelines for women aged 40-49 years: rationale for the American Cancer Society reaffirmation of recommendations. CA Cancer J Clin . 1994;;44:248-255.
2 +
Volkers N.  NCI replaces guidelines with statement of evidence. J Natl Cancer Inst . 1994;;86:14-15.
3 +
Moskowitz M.  Breast cancer: age-specific growth rates and screening strategies. Radiology . 1986;; 161:37-41.
4 +
Tabar L, Faberberg G, Day NE, Holmberg L.  What is the optimum interval between mammographic screening examinations? an analysis based on the latest results of the Swedish two-county breast cancer screening trial. Br J Cancer . 1987;; 55:547-551.
5 +
Feig SA.  Determination of mammographic screening intervals with surrogate measures for women ages 40-49 years. Radiology . 1994;;193:311-314.
6 +
Lindfors KK, Rosenquist CJ.  Needle core biopsy guided with mammography: a study of cost-effectiveness. Radiology . 1994;;190:217-222.
7 +
Parker SH, Burbank F, Jackman RJ, et al.  Percutaneous large-core breast biopsy: a multi-institutional study. Radiology . 1994;;193:359-364.
8 +
Bassett LW, Liu TH, Guiliano AE, Gold RH.  The prevalence of carcinoma in palpable vs impalpable mammographically detected lesions. AJR Am J Roentgenol . 1991;;157:21-24.
9 +
Baker LH.  Breast cancer detection demonstration project. CA Cancer J Clin . 1982;;32:194-225.
10 +
Sickles EA.  Periodic mammographic follow-up of probably benign lesions: results in 3184 consecutive cases. Radiology . 1991;;179:463-468.
11 +
Ellis H, Cox PJ.  Breast problems in 1000 consecutive referrals to surgical out-patients. Postgrad Med J . 1984;;60:653-656.
12 +
Donegan WL.  Evaluation of a palpable breast mass. N Engl J Med . 1992;;327:937-942.
13 +
US Dept of Commerce, Economics and Statistics Administration, and Bureau of the Census Vital Statistics. Statistical Abstract of the US, 111th ed . Washington, DC: US Government Printing Office; 1991;:84.
14 +
Parker SH, Lovin JD, Jobe WE, et al.  Stereotactic breast biopsy with a biopsy gun. Radiology . 1990;;176:741-747.
15 +
Schmidt R, Morrow M, Bibbo M, Cox S.  Benefits of stereotactic aspiration cytology. Admin Radiol . 1990;;9:35-42.
16 +
Eddy DM, Hasselmad V, McGivney W, Hendu W.  The value of mammography screening in women under age 50 years. JAMA . 1988;;259:1512-1519.
17 +
Ries LAG, Hankey BF, Miller BA, Hartman AM, Edwards BK, eds. Cancer Statistics Review, 1973-1988 . Bethesda, Md: National Institutes of Health; 1991;:Table II-43. National Institutes of Health publication 91-2789.
18 +
Tabar L, Fagerberg G, Duffy SW, Day NE, Gad A, Grontoft O.  Update of the Swedish two-county program of mammographic screening for breast cancer. Radiol Clin North Am . 1992;;30:187-210.
19 +
Shapiro S, Venet W, Strax P, Venet L, Roeser R.  Ten to fourteen year effect of screening on breast cancer mortality. J Natl Cancer Inst . 1982;;69:349-355.
20 +
Sickles EA, Kopans DB.  Deficiencies in the analysis of breast cancer screening data. J Natl Cancer Inst . 1993;;85:1621-1624.
21 +
Fletcher SW, Black W, Harris R, Rimer BK, Shapiro S.  Report of the international workshop on screening for breast cancer. J Natl Cancer Inst . 1993;;85:1644-1656.
22 +
Roberts MM, Alexander FE, Anderson TJ, et al.  Edinburgh trial of screening for breast cancer: mortality at seven years. Lancet . 1990;;335:241-246.
23 +
Tabar L, Fagerberg G, Duffy SW, Day NE.  The Swedish two county trial of mammographic screening for breast cancer. J Epidemiol Community Health . 1989;;43:107-114.
24 +
Andersson I, Aspegren K, Janzon L, et al.  Mammographic screening and mortality from breast cancer. BMJ . 1988;;297:943-948.
25 +
Ikeda DM, Andersson I, Wattsgard C, Janzon L, Linell F.  Interval carcinomas in the Malmo mammographic screening trial. AJR Am J Roentgenol . 1992;;159:287-294.
26 +
Colditz GA, Willett WC, Hunter DJ, et al.  Family history, age, and risk of breast cancer: prospective data from the Nurses' Health Study. JAMA . 1993;;270:338-343.
27 +
Slattery ML, Kerber RA.  A comprehensive evaluation of family history and breast cancer risk. JAMA . 1993;;270:1563-1568.
28 +
Mushlin AI, Fintor MA.  Is screening for breast cancer cost-effective? Cancer . 1992;;69:1957-1962.
29 +
Tengs TO, Adams ME, Pliskin JS, et al.  Five-hundred life-saving interventions and their cost-effectiveness. Risk Anal . 1995;;15:369-389.
30 +
Kattlove H, Liberati A, Keeler E, Brook RH.  Benefits and costs of screening and treatment for early breast cancer. JAMA . 1995;;273:142-148.
31 +
Cardenosa G, Eklund GW.  Screening mammography in women 40-49 years old. AJR Am J Roentgenol . 1995;;164:1104-1106.
32 +
Curpen BN, Sickles EA, Sollitto RA, Ominsky SH, Galvin HB, Frankel SD.  The comparative value of mammographic screening for women 40-49 years old versus women 50-64 years old. AJR Am J Roentgenol . 1995;;164:1099-1103.
33 +
Smart CR.  Highlights of the evidence of benefit for women aged 40-49 years from the 14-year follow up of the Breast Cancer Detection Demonstration Project. Cancer . 1994;;74:296-300.
34 +
Rosenquist CJ, Lindfors KK.  Screening mammography in women aged 40-49 years: analysis of cost-effectiveness. Radiology . 1994;;191:647-650.

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1 +
Mettlin C, Smart CR.  Breast cancer detection guidelines for women aged 40-49 years: rationale for the American Cancer Society reaffirmation of recommendations. CA Cancer J Clin . 1994;;44:248-255.
2 +
Volkers N.  NCI replaces guidelines with statement of evidence. J Natl Cancer Inst . 1994;;86:14-15.
3 +
Moskowitz M.  Breast cancer: age-specific growth rates and screening strategies. Radiology . 1986;; 161:37-41.
4 +
Tabar L, Faberberg G, Day NE, Holmberg L.  What is the optimum interval between mammographic screening examinations? an analysis based on the latest results of the Swedish two-county breast cancer screening trial. Br J Cancer . 1987;; 55:547-551.
5 +
Feig SA.  Determination of mammographic screening intervals with surrogate measures for women ages 40-49 years. Radiology . 1994;;193:311-314.
6 +
Lindfors KK, Rosenquist CJ.  Needle core biopsy guided with mammography: a study of cost-effectiveness. Radiology . 1994;;190:217-222.
7 +
Parker SH, Burbank F, Jackman RJ, et al.  Percutaneous large-core breast biopsy: a multi-institutional study. Radiology . 1994;;193:359-364.
8 +
Bassett LW, Liu TH, Guiliano AE, Gold RH.  The prevalence of carcinoma in palpable vs impalpable mammographically detected lesions. AJR Am J Roentgenol . 1991;;157:21-24.
9 +
Baker LH.  Breast cancer detection demonstration project. CA Cancer J Clin . 1982;;32:194-225.
10 +
Sickles EA.  Periodic mammographic follow-up of probably benign lesions: results in 3184 consecutive cases. Radiology . 1991;;179:463-468.
11 +
Ellis H, Cox PJ.  Breast problems in 1000 consecutive referrals to surgical out-patients. Postgrad Med J . 1984;;60:653-656.
12 +
Donegan WL.  Evaluation of a palpable breast mass. N Engl J Med . 1992;;327:937-942.
13 +
US Dept of Commerce, Economics and Statistics Administration, and Bureau of the Census Vital Statistics. Statistical Abstract of the US, 111th ed . Washington, DC: US Government Printing Office; 1991;:84.
14 +
Parker SH, Lovin JD, Jobe WE, et al.  Stereotactic breast biopsy with a biopsy gun. Radiology . 1990;;176:741-747.
15 +
Schmidt R, Morrow M, Bibbo M, Cox S.  Benefits of stereotactic aspiration cytology. Admin Radiol . 1990;;9:35-42.
16 +
Eddy DM, Hasselmad V, McGivney W, Hendu W.  The value of mammography screening in women under age 50 years. JAMA . 1988;;259:1512-1519.
17 +
Ries LAG, Hankey BF, Miller BA, Hartman AM, Edwards BK, eds. Cancer Statistics Review, 1973-1988 . Bethesda, Md: National Institutes of Health; 1991;:Table II-43. National Institutes of Health publication 91-2789.
18 +
Tabar L, Fagerberg G, Duffy SW, Day NE, Gad A, Grontoft O.  Update of the Swedish two-county program of mammographic screening for breast cancer. Radiol Clin North Am . 1992;;30:187-210.
19 +
Shapiro S, Venet W, Strax P, Venet L, Roeser R.  Ten to fourteen year effect of screening on breast cancer mortality. J Natl Cancer Inst . 1982;;69:349-355.
20 +
Sickles EA, Kopans DB.  Deficiencies in the analysis of breast cancer screening data. J Natl Cancer Inst . 1993;;85:1621-1624.
21 +
Fletcher SW, Black W, Harris R, Rimer BK, Shapiro S.  Report of the international workshop on screening for breast cancer. J Natl Cancer Inst . 1993;;85:1644-1656.
22 +
Roberts MM, Alexander FE, Anderson TJ, et al.  Edinburgh trial of screening for breast cancer: mortality at seven years. Lancet . 1990;;335:241-246.
23 +
Tabar L, Fagerberg G, Duffy SW, Day NE.  The Swedish two county trial of mammographic screening for breast cancer. J Epidemiol Community Health . 1989;;43:107-114.
24 +
Andersson I, Aspegren K, Janzon L, et al.  Mammographic screening and mortality from breast cancer. BMJ . 1988;;297:943-948.
25 +
Ikeda DM, Andersson I, Wattsgard C, Janzon L, Linell F.  Interval carcinomas in the Malmo mammographic screening trial. AJR Am J Roentgenol . 1992;;159:287-294.
26 +
Colditz GA, Willett WC, Hunter DJ, et al.  Family history, age, and risk of breast cancer: prospective data from the Nurses' Health Study. JAMA . 1993;;270:338-343.
27 +
Slattery ML, Kerber RA.  A comprehensive evaluation of family history and breast cancer risk. JAMA . 1993;;270:1563-1568.
28 +
Mushlin AI, Fintor MA.  Is screening for breast cancer cost-effective? Cancer . 1992;;69:1957-1962.
29 +
Tengs TO, Adams ME, Pliskin JS, et al.  Five-hundred life-saving interventions and their cost-effectiveness. Risk Anal . 1995;;15:369-389.
30 +
Kattlove H, Liberati A, Keeler E, Brook RH.  Benefits and costs of screening and treatment for early breast cancer. JAMA . 1995;;273:142-148.
31 +
Cardenosa G, Eklund GW.  Screening mammography in women 40-49 years old. AJR Am J Roentgenol . 1995;;164:1104-1106.
32 +
Curpen BN, Sickles EA, Sollitto RA, Ominsky SH, Galvin HB, Frankel SD.  The comparative value of mammographic screening for women 40-49 years old versus women 50-64 years old. AJR Am J Roentgenol . 1995;;164:1099-1103.
33 +
Smart CR.  Highlights of the evidence of benefit for women aged 40-49 years from the 14-year follow up of the Breast Cancer Detection Demonstration Project. Cancer . 1994;;74:296-300.
34 +
Rosenquist CJ, Lindfors KK.  Screening mammography in women aged 40-49 years: analysis of cost-effectiveness. Radiology . 1994;;191:647-650.

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